Sara A. Martin, MSc
Harvard Medical School, Class of 2017
Pisacano Scholar, Class of 2015
The opinions and views expressed here are those of the author and do not necessarily represent or reflect the opinions of the Starfield Summit or its funders. This blog is not intended to provide medical, financial, or legal advice.
Last year, over a hundred key policy makers gathered in the center of Washington D.C. last year for the first annual Starfield Summit. The Summit was named after Barbara Starfield, a prolific primary care researcher who, as described at the Summit, “revealed that countries and areas with health systems that are primary care oriented have better population health outcomes, higher quality care, greater health equity, and lower costs.”
At the Summit, United States policy makers visualized a system where primary care physicians could truly take care of whole communities as opposed to just their registered list. The room dreamt of what this could look like, coming up with solutions that blurred the line between social and primary care, and tackled health where it started. As one policy maker said, “the center of health care should be family and community, not the doctor.”
In the United States, places such as Iora Health are leading these attempts. Through proactive outreach to patients, they are meeting patients where they are and often before they even know they need it. For example, Iora Health has re-envisioned diabetes care to include a trip to the market. There they can walk with the patient through the store, demonstrating how to read nutrition labels and giving tips for avoiding troublesome foods. Other groups such as Health Leads allow physicians to practice social prescribing (e.g. recommending a knitting group for an isolated person), an idea gaining traction in the United Kingdom too.
However, in the United States these “bright spots” remain anomalies; we are hindered by an insurance-based system that still leaves too many people without access to health care services. As one policy maker and physician said, “It’s not a health system, it’s a wealth extraction system.” We are also hampered by the most common financial model—fee-for-service—which pays us only for tangible services rendered. It does not measure—or pay for—that which never happened: the woman who never got diabetes, the man who never had a heart attack, the hospital admission that was avoided.
This year’s Starfield Summit (April 22-25) will focus on the social determinants of health. It will move beyond the first Summit, from how healthcare can be shaped to have family and community at the center, to how family and community can shape health. It is guaranteed to be an inspiring weekend, full of passionate movers and shakers for whom there is little question as to the importance of community within medical care.
It is important, however, that the second Starfield Summit occurs within the context of the first Summit, using measurement, payment, and new models of care as a frame for discussions. How can measurement, payment, and new models of care be changed and mobilized to improve social determinants of health? Framing the conversation this way will help the primary care community to move past the bright spots to unlock the potential—and the power—of the medical community to help ameliorate the social determinants of health.